State of undress patient privilege?

April 19, 2007

ON ETHICS RANDY COHEN Q. When I went for an examination, my surgeon asked if two residents could be present. I felt uncomfortable being undressed in front of extra people, and so I declined. My surgeon scolded me, saying I was preventing the next generation of doctors from being trained. Why is it my responsibility to provide training for medical students? A. Your surgeon's request was reasonable; her brow-beating you was not. She's right that a new physician's education must include work with actual patients, under the supervision of a wily veteran like herself. Because you, like all of us, rely on the skills of physicians trained in this way, you have a general obligation to reciprocate, to assist the next generation of patients as the past generation of patients has assisted you. Happily for you, this training needs the participation of many patients but not all. Some are profoundly uncomfortable when being examined, particularly by strangers, particularly when those extra doctors are not medically necessary. Feeling as you do, you may decline your surgeon's request, a decision she must accept graciously: no scolding, no eye-rolling. Her primary obligation is the well-being of her current patient, not the training of her future colleagues. But if you demur, you should find another way to do your fair share for the health care community of which you are a member and from which you benefit. Give blood, sign your organ-donor card, arrange to donate your body to science, give money to your hospital. There are many ways to contribute; I'm sure that your physician herself can suggest some. Q. I am a volunteer firefighter. I responded to an accident involving someone I knew to be infected with hepatitis C, a contagious disease. As we cut the roof off her car to remove this injured and bleeding woman, two police officers approached to administer first aid. They were not wearing protective gloves, so I offered each a pair; they declined. Should I have revealed her medical condition? Should I inform those officers now so they can be tested and perhaps treated? A. Your concern for the privacy of your injured acquaintance is admirable, but yes, you should have alerted those police officers to their serious, imminent danger. Their peril superseded her claims to confidentiality. These officers were -- what's the word? knuckleheads! -- not to have donned their gloves already. Surely they were trained to. Had they observed this protocol for administering first aid, they would have shielded themselves from the blood-borne diseases any victim might carry and dodged a clash between their safety and a victim's privacy. You should have warned them (avoiding the word "knucklehead") by offering the minimum information necessary, i.e., by declaring that you knew her to have an infectious disease. If those doofuses still eschewed protective gear, you could then have said that she's a vampire. OK, not a vampire, but you could have progressed gradually but swiftly from the general to the particular, mentioning her specific condition only as a last resort. Having failed to do that, you must now urge them to get tested, which means revealing what they must be tested for. Update: The reader spoke to the victim, who volunteered to notify the rescue workers herself. Readers can direct their questions and comments by e-mail to ethicist@nytimes.com. This column originates in The New York Times Magazine.